Amid violence, denial and fear, HIV spreads

Before discovering his HIV status, Kiukiu Barnabe saw villagers near his home in Papua New Guinea's remote highlands force a young woman living with HIV to live inside a 2m-deep hole that eventually became her grave.

Terrified of catching her illness, the villagers covered the hole with canvas and dropped food inside. Less than a month later, she died.

"I couldn't do anything. I didn't know my status then, and I was scared of her, too," Barnabe, 38, said from the small office of the 68-member Minivava Network for people living with HIV in Goroka, the main town of Eastern Highlands Province.

In June, during a break at one of his talks about testing and treatment, a young man approached Barnabe with a confession. His sister was HIV-positive. One night as she slept, he and his neighbours tied her arms and legs and put her in a coffin. She woke up and screamed for help as they nailed it shut. They buried her alive.

"The boy came up to me and said he didn't know about treatment," Barnabe recalled. "He apologized and said, 'I thought I would get the virus from her. I didn't have the information, and so I buried her. I made the wrong decision'."

Ignorance

Lack of knowledge about HIV has resulted in ostracism, violence, even accusations of sorcery and murder, pushing people living with the virus to hide their status and continue spreading it to sexual partners.

This mountainous Pacific island country, with 6.7 million people, is one of the world's most ethnically diverse, with 800 different languages. Polygamy is customary, while tribal fighting, violence against women and rape are widespread, complicating awareness campaigns.

"The most challenging thing is that people don't have adequate information on HIV/AIDS because we have so many languages here... it takes time for it to be translated into local dialects," said Peterson Magoola, an HIV/AIDS specialist with the UN Development Programme (UNDP).

While recent analysis of available data across the country shows that the epidemic is starting to level off, the government's National AIDS Council Secretariat estimates 34,100 people are living with HIV, but that figure is believed to be significantly underestimated.

"It's much, much more than this," Magoola said. "The epidemic is spreading more in rural areas, where we can't get tangible data on the magnitude of the epidemic, so we don't know what response to use to reach those rural areas."

Stigma, fear and spreading virus

One day, Evelyn Dilia* felt ill, and her husband - out of the blue - suggested she might be infected with HIV. Taken aback by the suggestion, she went to a clinic to get tested. By the time she returned home, her husband was gone.

"He never came back to me. He knew he had passed the virus on to me," said Dilia, a mother of three, who is also a Minivava member. "I know that he infected me. If he didn't know his status, he wouldn't have told me, 'Maybe you are infected'."

Now, Dilia works with the Clinton Foundation to answer questions from others who have contracted the virus. She says many keep their status secret.

One man told Dilia that although he knew his status, he got a woman pregnant.

"He said, 'What will I tell her? I didn't want her to leave me so I hid it from her'," she said.

Many women are abused and kicked out of their homes when they reveal their HIV status, and some then turn to sex work to survive.

"We cannot say that it's wrong," said Angela Kaupa, president of Minivava. "They need to have money, they need to have a living. That is their right."

The government estimates about 40 percent of men used a condom in the past year.

Magoola said the HIV epidemic in PNG was similar to that in Africa, in that the main mode of transmission is heterosexual transmission and multiple sexual partners, and increasing condom use is important in such a context. He said condom use was much higher in some African countries where awareness campaigns have long been in place.

"Forty percent is low. What about the other 60 percent? More has to be done in terms of condoms as a preventive measure," he said.